East and Central African Journal of Surgery最新文献

{"title":"Abstracts of the College of Surgeons of East, Central and Southern Africa (COSECSA) 19th Annual General Meeting and International Scientific Conference","authors":"College Of Surgeons of East, Central and Southern Africa","doi":"10.4314/ecajs.v23i3.8","DOIUrl":"https://doi.org/10.4314/ecajs.v23i3.8","url":null,"abstract":"Conference Abstracts","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131851338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mature teratoma with aspergilloma","authors":"Abebe Bezabih, A. Atnafu","doi":"10.4314/ecajs.v23i3.6","DOIUrl":"https://doi.org/10.4314/ecajs.v23i3.6","url":null,"abstract":"Mediastinal mature teratomas are benign germ cell tumors which rarely involve the lung, but when they involve the lung they can cavitate. Aspergilloma developing in a mature teratoma is extremely rare, and according to our English literature search, there is only one previously reported case. We report a 21-year-old female who presented with cough and foul-smelling sputum. investigations revealed an intrathoracic mass, which intraoperatively and upon subsequent histological exam was found to be a mature mediastinal teratoma involving the lung and associated with an aspergilloma. Reporting our case will add to the understanding of this rare presentation of mediastinal mature teratomas. Keywords: mature teratoma; aspergilloma; surgical treatment ","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127629524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching surgical skills in a resource-limited setting: Comparing massed versus distributed practice in an ultrasound-guided breast biopsy simulator","authors":"Robert Munyaneza, Allison N. Martin, R. Riviello, E. Abahuje, S. Murthy, F. Ntirenganya","doi":"10.4314/ecajs.v23i3.1","DOIUrl":"https://doi.org/10.4314/ecajs.v23i3.1","url":null,"abstract":"Background: Teaching surgical skills in the simulation lab has increased markedly compared to teaching only in the operating room. Although many studies have been performed investigating the optimal teaching methodology for skills acquisition, there is no consensus on the best method. Massed and distributed practices are important methods in teaching procedural skills. Considering the limited human and logistical resources in low and middle-income settings, it is valuable to understand the optimal methodology for learning and acquiring surgical skills. Methods: Thirty-two core needle biopsy-naïve first-year residents and final year medical students rotating in general surgery were enrolled in and completed the study at University Teaching Hospital of Kigali, a tertiary, teaching and referral hospital in Kigali, Rwanda. They were assigned to a “massed” group (i.e., one time, 3-hour practice) or “distributed” group (i.e., 1-hour practice per week for 3 weeks). Trainees were taught ultrasound-guided core needle biopsy on a high-fidelity breast simulator. All participants completed pre- and post-tests and an evaluation of skill retention was performed one month after completion of the training. Analysis of performance was completed, and p-value ≤ 0.05 was considered statistically significant. Results: There was no difference between performance on the pretest (p=0.985) and the posttest (p=0.680). Both groups demonstrated improvement after implementation of the simulation training when comparing pretest and posttest results (p<0.001); there were no differences in the evaluation of skills retention after one month after the training between the two groups (p=0.273). Conclusions: The results of this study demonstrate that both groups have improved significantly their knowledge and skills. Trainees have similar retention of skills in ultrasound guided core needle biopsy on a breast simulator whether trained under a massed or distributed practice schedule. Both methods may be considered in our setting for teaching surgical skills. Keywords: surgical simulation; resource-limited setting; global surgery ","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123875734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic diaphragmatic hernia complicating pregnancy","authors":"Brightson Mutseyekwa, Mordecai Sachikonye, Lameck Chiwaka, N. C. Changata","doi":"10.4314/ecajs.v23i2.7","DOIUrl":"https://doi.org/10.4314/ecajs.v23i2.7","url":null,"abstract":"Intestinal obstruction in pregnancy is rare but has a high maternal and foetal mortality. We present a case of 32-year-old patient who presented in her 2nd trimester of pregnancy with signs and symptoms of large bowel obstruction. An exploratory laparotomy revealed that the transverse colon had herniated through a diaphragmatic tear as the cause of the intestinal obstruction. The delays in presentation and diagnostic dilemmas associated with intestinal obstruction in pregnancy are manifested in this case. Keywords: intestinal obstruction; pregnancy; diaphragmatic hernia ","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"111 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124057618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilonidal sinus disease: Case report and review of the literature","authors":"O. Olawoye, I. O. Obadan, J. Choji","doi":"10.4314/ecajs.v23i2.8","DOIUrl":"https://doi.org/10.4314/ecajs.v23i2.8","url":null,"abstract":"Pilonidal sinus disease is a chronic granulomatous condition resulting from the presence of hair in the subcutaneous tissues. Its treatment ranges from simple hygiene measures to complex surgical interventions depending on the mode of presentation. We present a 59-year-old man who had a history of re-current swelling in the left gluteal region of about 2 years duration. After a diagnosis was made of pilonidal sinus disease, he had open surgery with laying open of the sinus and exploration with a probe in the operating room under local anesthesia. The sinus measured about 4 cm. He had drainage of the sinus cavity with curettage of the floor of the sinus. Pilonidal sinus disease may not be as uncommon in our setting as previously thought. A high index of suspicion should be entertained based on the characteristic location and typical presentation of the condition. Keywords: pilonidal sinus; pilonidal disease; pilonidal cavity ","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"212 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117286973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe gynaecomastia associated with highly active antiretroviral therapy","authors":"F. Muchemwa, Clarice T. Madziyire","doi":"10.4314/ecajs.v23i2.6","DOIUrl":"https://doi.org/10.4314/ecajs.v23i2.6","url":null,"abstract":"The association between gynaecomastia and HIV infection was first reported in 1987; however, there were no subsequent published reports of gynaecomastia linked to HIV infection until highly active antiretroviral therapy (HAART) was introduced. Although HAART significantly improves the prognosis of HIV infection, its extensive use has resulted in multiple adverse effects, including benign breast enlargement. We present a rare case of severe gynaecomastia in a male patient with vertically transmitted HIV on HAART. He was surgically treated with mastectomy with no nipple-areolar complex reconstruction. The pathology report confirmed the benign nature of the breast tissue. Surgical intervention resulted in an improvement of daily activities and enhanced psychosocial wellbeing. Benign bilateral breast enlargement of this magnitude in a male patient has never been reported. Keywords: gynaecomastia; HIV; highly active antiretroviral therapy; efavirenz ","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131466953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of aortic arch anatomical branching variants in Kenyan population as shown on contrast enhanced chest multidetector computed tomography","authors":"D. M. Amakabane, G. Mwango","doi":"10.4314/ECAJS.V23I2.4","DOIUrl":"https://doi.org/10.4314/ECAJS.V23I2.4","url":null,"abstract":"Background: The objective of the study was to determine the prevalence of aortic arch(AA) anatomical branching variants present in Kenyan population as shown on a chest contrast-enhanced multidetector computed tomography (MDCT). Methods: The study design was a prospective cross-sectional study carried out in 6 months (between May and November 2016) at the Kenyatta National Hospital(KNH) department of Radiology. Participants were recruited amongst patients referred for a chest contrast enhanced MDCT. Acquired data was subjected to volume rendering technique (VRT) and multiplanar reconstruction (MPR) software to define the anatomy of the AA. The type of AA branching classification used was one derived by Natsis et al. Data analysis involved calculating frequency distributions of AA variations using Statistical Package for Social Sciences version 21 software. Results: One hundred and eighty-five subjects (86 males and 99 females) were recruited. Ninety-five participants had classical AA Natsis type I. Ninety participants had non-classical variant AA of which 83 participants had Natsis type II while 2 patients had Natsis type III. The remaining 3 had a variant AA not found in the Natsis study. Conclusions: Variations in the branching pattern of AA are very common in Kenya with the most common being Natsis type II. Keywords: aortic arch; anatomical variants; branching variation; chest multidetector computed tomography","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125013344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pattern of surgical admissions to Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A five-year retrospective study","authors":"Sahlu Wondimu, Solomon K Bekele, Dawit G. Giorgis, F. Getachew, N. Seyoum","doi":"10.4314/ecajs.v23i2.3","DOIUrl":"https://doi.org/10.4314/ecajs.v23i2.3","url":null,"abstract":"Background: Tikur Anbessa specialized hospital (TASH) is Ethiopia’s largest tertiary teaching and referral hospital admitting and treating surgical patients under various specialties. This study aims to analyze the magnitude and pattern of surgical admissions to this facility. Methods: A five-year Cross sectional retrospective analysis was done on all adult surgical admissions to TASH from Sept. 2010 to Sept. 2015. Results: There were a total of 8,698 surgical admissions of which, 4471 (51.4%) were male and 4227 (48.5%) were female with male to female ratio of 1.06:1. Their age ranged from 13 to 95, with mean age being 38.8 ± 16.2 years. Three thousand two hundred twenty two (46.5%) patients were from Addis Ababa. Of all admissions, 4706 (54.1%) were elective ones of which obstructive uropathy, 997(21.1%), esophageal diseases, 716(15.2%) and Urolithiasis, 573(12.2%) respectively are the top three. The rest, 3992 (44.9%), were emergency admissions, the top three ones being trauma, 1435(35.9%), appendicitis 281(7%) and Intestinal obstruction, 190(4.7%) respectively. General surgical (gastrointestinal, endocrine and vascular) cases account for 3414 (39.25%) of all admissions followed by urosurgical cases, 2114 (25.31%), cardiothoracic surgical cases, 1942 (22.33%), and neurosurgical cases, 1139 (13.1%). There were a total of 280 deaths with an overall mortality rate of 4% of which, 3.2% were from elective admissions and 5.2% from emergency ones. Mortality rate was the highest among neurosurgical patients being 6.3% followed by 4.3%, 3.8% and 3.5% in cardiothoracic, general surgical and urosurgical cases respectively. Conclusions: The admission pattern indicates quite a big number and diversity of cases though the bed capacity is limited. There are significant number of cases that could be treated at other secondary level hospitals. Trauma is the leading cause of emergency admissions and significant cause of mortality. We recommend increasing the number of beds, organizing separate trauma center and admitting only cases requiring tertiary level care. Keywords: pattern of surgical diseases; surgical admissions; Tikur Anbessa Specialized Hospital","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131148768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior mediastinal Castleman’s disease with vascular malformation","authors":"A. T. Tamire","doi":"10.4314/ecajs.v23i2.5","DOIUrl":"https://doi.org/10.4314/ecajs.v23i2.5","url":null,"abstract":"Castelman’s disease (CD) is a rare lymphoproliferative disorder of unknown aetiology, with the unicentric form usually involving the chest. Posterior mediastinal involvement is uncommon, exceedingly so when associated with vascular malformation. We report the case of a young female patient who presented with 9 months of left-sided, dull chest and flank pain associated with weight loss and a subjective tingling sensation. Imaging reveled a well-circumscribed hyper-enhancing posterior mediastinal para-oesophageal mass. She underwent a right posterolateral thoracotomy, mass excision. Histopathologic examination confirmed Castleman’s disease (CD) with arteriovenous malformation. CD with vascular malformation is a very rare condition that can only be diagnosed histopathologically. Surgical resection is effective and has a good prognosis. Keywords: Castleman’s disease; AV malformation; posterior mediastinum ","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"362 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116360196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delay of emergency surgical interventions in Ethiopia: Patient and health system factors","authors":"G. Tamrat, M. Osman, Nigussie Deyessa, Mulat Taye, R. Lett, A. Bekele","doi":"10.4314/ECAJS.V23I2.2","DOIUrl":"https://doi.org/10.4314/ECAJS.V23I2.2","url":null,"abstract":"Background: The objectives of this study were to evaluate outcomes among patients with acute abdomen and abdominal trauma who presented at either of 2 referral hospitals in Addis Ababa, Ethiopia, and to determine the factors associated with delay as well as the effects of prehospital and in-hospital delay on outcome. Methods: We conducted a 1-year prospective cross-sectional study, which included all cases of surgically treated acute abdomen and abdominal trauma admitted to St Paul General Specialized Hospital, Addis Ababa, Ethiopia and Gondar University Hospital, Gondar, Ethiopia. Standardized data collection forms were completed for all cases from 1 May 2008 to 30 April 2009. Data were analyzed using Epi Info version 6 and SPSS version 13. Results: A total of 504 patients were studied. Diagnoses were: intestinal obstruction (34.6 %), appendicitis (33 %), and perforated peptic ulcer (3.6 %). Sixty-six percent of patients over 45 years of age, 60% of females, and 61% of intestinal obstruction cases were operated on within 3 days of illness onset. The 35% of patients who were operated on more than 3 days after the development of symptoms had a mortality of 67%. Fifty-four percent of the cases with a total prehospital and in-hospital time of more than 3 days had initially visited other health institutions. Conclusions: Delay of surgical intervention of more than 3 days for acute abdomen or abdominal trauma adversely affected outcomes. Women, patients older than 45 years of age, patients with intestinal obstruction, and those who were referred from other health facilities were delayed and had adverse outcomes. Keywords: delay in surgery; acute abdomen; abdominal trauma; surgical systems improvement ","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128661104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}